STREAMLINED PROCESS FOR PHARMACIES TO CONFIRM PATIENTDIAGNOSIS AND TREATMENT PLAN

An Overview & Process Guide

Patient Advocate Foundation-Confidential: Do NotDistribute Externally

STREAMLINED PROCESS FOR PHARMACIES TO CONFIRMPATIENT DIAGNOSIS AND TREATMENT PLAN

Patient Advocate Foundation Co-Pay Relief Program (CPR)is excited to announce we have enhanced the process of verifying the patient’s diagnosis and treatment plan!

Our goal is to reduce the burden of verifying the patient’s diagnosis by enabling authorized pharmacy staff members, to verify the patient’s diagnosis during the application process.

This new process is effective for all applications submitted on or afterJune 14, 2019

STREAMLINED PROCESS FOR PHARMACIES TO CONFIRM PATIENTDIAGNOSIS AND TREATMENT PLAN

As an alternative to submitting the Physician Form that has historically been required by the program, the patient’s diagnosis and treatment plan can be r e p o r t ed a n d v e r i f i ed b y t h e a u t h o r i z ed ph a r m ac y r e p r ese nt a t i v es as a step in the application process!

During Step 6 of the application process the following information will need to be provided,verified and attested to:

– Information about the treating physician– Information about the authorized pharmacy representative completing the application– The patient’s diagnosis, including name of condition and/or ICD-10 code(s) and stage

of disease (as applicable)– Information about the patient’s treatment plan– Authorized pharmacy representative’s attestation confirming the accuracy of the

diagnosis and treatment plan information being reported• The attestation can be done v e rball y when applying via phone or e l ec t r o ni ca ll y si g n ed

when applying via the pharmacy portal– Supporting documentation from the pharmacy system that confirms the diagnosis and

treatment information for the patient, as provided by the prescriber to the pharmacy, for review (can be uploaded during the application process or faxed)

This new process is effective for all applications submitted on or after June 14, 2019.

STREAMLINED PROCESS FOR PHARMACIES TO CONFIRM PATIENTDIAGNOSIS AND TREATMENT PLAN

Examples of acceptable supporting documentation include but are not limited to:• Screenshots of patient record from pharmacy

In order for the authorized pharmacy representative to verify the patient’s diagnosis and treatment plan during the application process, documentation from the pharmacy system that confirms the diagnosis and treatment information for the patient, as provided by the prescriber to the pharmacy MUST be submitted to the program for review.

system• Copy of prior authorization• Copy of Benefits investigation• Screenshots of required information from

electronic prescription request• Copy of chart notes or communications from

provider that includes required informationAcceptable supporting documentation provided by the pharmacy MUST include the following information

• Patient Name• Patient Date of Birth• Diagnosis Name• Diagnosis ICD-10• Treating Physician Name• Facility Name• Provider NPI• Medication being prescribed and dispensed

This new process is effective for all applications submitted on or after June 14,

2019.

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Step 6_Se nformatio erson com

STREAMLINED PROCESS FOR PHARMACIES TO CONFIRM PATIENTDIAGNOSIS AND TREATMENT PLAN

Step 6_Section 1: The selected treating physician will automatically pre-populate at the t screen will based on the portal registration information

ction 2: The authorized pharmacy representative must fill out all required i n of p pleting the application

This new process is effective for all applications submitted on or after June 14, 2019.

Helpful Tips:– When selectin

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drop down m– If the Primary– If the ICD-10/_Section 4: Enter

STREAMLINED PROCESS FOR PHARMACIES TO CONFIRMPATIENT DIAGNOSIS AND TREATMENT PLAN

Step 6_Section 3: Complete the required Diagnosis and Treatment Information fields.

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Diagnosis enu.Diagnosis is selected; the ICD-10/Diagnosis Code will automatically populate.

Diagnosis Code is selected; the Primary Diagnosis will automatically populate.

Step 6 the list of current medications included in the patient’s treatment plan

This new process is effective for all applications submitted on or after June 14, 2019.

on that verifies the patient’s diagnosis and tr ps below. Or, it can be faxed to the program upload Supporting Documentation:Browset the document that verifies the patient’s diaOpenUpload Documentocument will then appear under the Attachm

STREAMLINED PROCESS FOR PHARMACIES TO CONFIRM PATIENTDIAGNOSIS AND TREATMENT PLAN

Part 6_Step 5: The authorized pharmacy representative will be required to provide supporting documentati eatment plan. This can be uploaded using the ste .• Steps to

- Click- Selec gnosis and treatment- Click- Click- The d ents

• Patient Date of Birth

This new process is effective for all applications submitted on or after June 14, 2019.

STREAMLINED PROCESS FOR PHARMACIES TO CONFIRM PATIENTDIAGNOSIS AND TREATMENT PLAN (cont’d)

Example of an attached pharmacy document:

• Patient Date of Birth

This new process is effective for all applications submitted on or after June 14, 2019.

ote: A pharmacy may opt not to utilize the instant verification process to confirm a patient’s dia eatment plan. In this case, select “NO” to the attestation statement and a physician form will b ovider office for completion.

• If YES is selected – supporting documentation that verifies the patient’s diagnosi uploaded during the application process.

s m

a completed physician form will be required.

STREAMLINED PROCESS FOR PHARMACIES TO CONFIRMPATIENT DIAGNOSIS AND TREATMENT PLAN

Part 6_Step 6: The authorized pharmacy representative can attest to the accuracy of the diagnosis and treatmentplan of the patient and that he/she has permission to complete this information on behalf of the patient by selecting“YES”.N gnosis andtr e sent to thepr

ust be

• If NO is selected –

• Once a “YES” OR “NO” selection is made, click “next” to review the agreement terms and conditions then electronically sign and submit the application.

This new process is effective for all applications submitted on or after June 14, 2019.

STREAMLINED PROCESS FOR PROVIDERS TO CONFIRM PATIENTDIAGNOSIS AND TREATMENT PLAN

Step 6_ Sections 1-6 Summary: The the application process allows the authorized pharmacy representative to provide verification of the patient’s diagnosis and treatment plan.

• Patient Date of Birth

This new process is effective for all applications submitted on or after June 14, 2019.

STREAMLINED PROCESS FOR PHARMACIES TO CONFIRM PATIENTDIAGNOSIS AND TREATMENT PLAN

Important Reminders:

• The information submitted to verify the patient’s diagnosis will be reviewed by our staff to ensure compliance with program guidelines. If additional information is needed, our staff will contact the pharmacy directly.

• If the authorized pharmacy representative does not attest to the patient’s diagnosis and treatment plan during the application process a n d upload required documentation; acceptable documentation verifying the patient’s diagnosis must be submitted by the provider within 30 days of the creation of the application, or the patient’s award will be rescinded.

• This process change is applicable to new and/or renewal application i n iti a t e d o n o r a f t e r June 14, 2019. Any applications submitted prior to this date must have a signed physician diagnosis verification form on file.

• For personal assistance with the application process, please call us toll free at 866-512-3861.

This new process is effective for all applications submitted on or after June 14, 2019.

421 Butler Farm Road

Hampton, VA 23666Phone: (866) 512-3861

Fax: (757) 952-0119

Internet: ww w . c op a y s .o r g

E-Mail: c p r @p a ti e n t ad v o c a t e .o r g